Total Endoprosthetic Replacement Research Articles

Tibia Adamantinoma Resection and Reconstruction with a Custom-Made Total Tibia Endoprosthesis: A Case Report with 8-Year Follow-Up

This case study describes a total tibia resection and reconstruction with a custom-made endoprosthetic replacement (EPR) and a long-term, 8-year follow-up. The patient underwent a total tibia adamantinoma resection in 2009. Reconstruction was performed with a custom-made total tibia EPR, where both the knee joint and ankle joint were reconstructed. Two muscle flaps, latissimus dorsi free flap and a pedicled medial gastrocnemius flap, were used for soft tissue reconstruction. The patient returned to normal life as a kindergarten teacher, without complications for eight years. This case demonstrated the importance of successful multidisciplinary teamwork in close collaboration with industry. In our best knowledge, no over 2 years of follow-up of total tibia replacement reports have been published.

Microcrystalline stress in the pathogenesis of osteoarthritis

To estimate the rate of articular cartilage microcrystallization in osteoarthritis (OA). The investigation included 110 people who had undergone total endoprosthetic replacement for coxarthrosis. A total of 50 patients with total hip endoprosthetic replacement for femoral neck fractures were recruited as a comparison group. An X-ray diffractometer was used to detect crystals. Cartilage mineralization was seen in 72% of the patients with late-stage OA. Articular cartilage microcrystalline stress is a constant sign of late-stage OA requiring further clinical interpretation.

Arthropathia ochronotica: eine seltene Ursache frühzeitiger Gelenkdegeneration

A 70-year-old deaf-mute women suffered from progressive chronic pain of the right hip joint caused by destructive osteoarthritis of the hip. In addition to painfully restricted range of motion of the right hip joint the clinical examination showed a bluish-black pigmentation of the ear-cartilage and the sclera. A total endoprosthetic replacement of the right hip joint was performed. During surgery, blackening of the hip joint capsule and cartilage was found. Histological, the diagnosis of an ochronosis was confirmed. Discoloration after exposure of urine to air supported the diagnosis. Based on extensive internal medical examination relevant cardiac changes were excluded. Ochronosis (arthropathia ochronotica) is a rare entity which can be identified by a visual diagnosis. Early diagnosis can provide crucial information for the prognosis. Additionally, an interdisciplinary treatment concept should be established because of the early onset of degenerative changes at the skeletal system and pathological changes at internal organs. With suspicion on an ochronosis extended internal examinations are recommended in order to avoid complications.

Distal Femur Allograft Prosthetic Composite Reconstruction for Short Proximal Femur Segments following Tumor Resection

Short metaphyseal segments remaining after distal femoral tumor resection pose a unique challenge. Limb sparing options include a short stemmed modular prosthesis, total endoprosthetic replacement, cross-pin fixation to a custom implant, and allograft prosthetic composite reconstruction (APC). A series of patients with APC reconstruction were evaluated to determine functional and radiologic outcome and complication rates. Twelve patients were retrospectively identified who had a distal femoral APC reconstruction between 1994 and 2007 to salvage an extremity with a segment of remaining bone that was less than 20 centimeters in length. Seventeen APC reconstructions were performed in twelve patients. Eight were primary procedures and nine were revision procedures. Average f/u was 89 months. Twelve APC reconstructions (71%) united and five (29%) were persistent nonunions. At most recent followup 10 patients (83%) had a healed APC which allowed WBAT. One pt (8%) had an amputation and one pt (8%) died prior to union. Average time to union was 19 months. Four pts (33%) or five APC reconstructions (29%) required further surgery to obtain a united reconstruction. Although Distal Femoral APC reconstruction has a high complication rate, a stable reconstruction was obtained in 83% of patients.

Use of Tranexamic Acid during Total Endoprosthetic Replacement of the Hip Joint

Objective: to evaluate the blood-saving activity, efficacy, and safety of tranexamic acid. Subjects and methods. Thirty-seven patients allocated into two groups were enrolled in the study of the efficacy of tranexamic acid as an agent in reducing blood loss during hip joint replacement. Group 2 patients were injected tranexamic acid, 10 mg/kg body weight, 20—30 minutes before and 3 hours after surgery in the same dosage. This resulted in a significant (48.5%) reduction in total blood loss (from 1089.6 to 560.8 ml) (p<0.05). No tranexamic acid-induced complications were found. The administration of tranexamic acid during total endoprosthetic replacement of the hip joint could reduce blood loss by 35 and 59.4% in the intraoperative and postoperative periods, respectively, and total blood loss by 48.4%. The use of tranexamic acid allows one to refuse transfusion of blood components during total endoprosthetic replacement of the hip joint. Key words: hip joint replacement, blood loss, tranexamic acid.

Primäre Alloarthroplastik des frakturierten Ellenbogens beim hochbetagten Patienten

Inadequate treatment of distal intra-articular fractures of the humerus results in painful restriction of movement or malarticulation. Especially in geriatric patients with osteoporosis, stable osteosynthesis can be difficult. Primary total endoprosthetic replacement of the cubital joint could offer an alternative. In 12 patients with a distal intra-articular fracture of the humerus a cemented semi-constrained Coonrad-Morrey prosthesis was implanted. Patient were followed-up after an average of 13 months and assessed according to the Mayo score. In 6 patients additional computerized tomography was carried out. Minimally invasive Kirschner wire osteosynthesis resulted in immediate postoperative loss of correction due to osteoporosis. As with the external distraction-compression apparatus the ulnar pinholes can form a predetermined breaking point and fixation in a long-arm cast is recommended. The mean Mayo score was 90.5 points and mean range of motion in extension/flexion was 84.5 degrees. In elderly patients primary endoprosthetic treatment of a distal intra-articular fracture of the humerus with a semi-constrained cemented prosthesis may offer an alternative to osteosynthesis thus enabling creation of a mobile, painless and stable cubital joint.

Bone Formation Zones in Heterotopic Ossifications: Histologic Findings and Increased Expression of Bone Morphogenetic Protein 2 and Transforming Growth Factors ß2 and ß3

Heterotopic ossifications (HOs) formed after total endoprosthetic replacement of the hip joint were collected during revision surgery (n = 7). Tissues collected during regular hip arthroplasty (n = 12) were used as reference. Histomorphometric analysis was performed for assessment of bone formation activity in HOs and reference bone. HOs were dissected with histological guidance into three zones: formed bone, zone of active bone formation, and zone with fibrous connective and fibrocartilagineous tissue. Relative expression of the mRNA for bone morphogenetic protein 2 (BMP-2), transforming growth factor beta2 (TGF-beta2), and TGF-beta3 was determined by reverse-transcription polymerase chain reaction relative to beta-actin. Expression of all three growth factors was higher than in orthotopic bone. Similarly, the osteoid surface density was increased in HOs. The levels of all growth factors were higher in the zone of active bone formation or remodeling than in the zone of formed bone. In matured HOs, the osteoid surface density as well as mRNA levels were lower, although still significantly raised, indicating that bone formation slows down after 2 years. Immunohistochemical analysis demonstrated the presence of TGF-beta1, TGF-beta2, TGF-beta3, and BMP-2 proteins in the zone of bone formation. We conclude that bone formation after heterotopic bone induction is initially intense, slows down within 2 years, and thereupon continues as active remodeling mainly on the border of HO. Our data indicate that BMP-2, TGF-beta2, and TGF-beta3 are involved in bone formation in HO.

Langzeitergebnisse der Resektionsarthroplastik der Fingergrundgelenke

The metacarpophalangeal arthroplasty in rheumatoid arthritis reported is a modification of the Vainio-Arthroplasty. The main difference of the technique is the fixation of the proximal extensor tendon to the palmar plate, better to the ligamentum metacarpeum transversum profundum. The more flexion of the metacarpophalangeal joint the more reposition of the joint is achieved. The long-term results of 30 arthroplasties of the metacarpophalangeal joint are presented in a prospective study. The cases were followed for 10.5 to 14.5 years (average 11.6 years). Marked release of pain was found in all patients. 75 per cent of the patients reported functional improvement of their hand at a score of "good" or "very good". The postoperative movement was 70 degrees on an average. In summary, the resection arthroplasty of the metacarpophalangeal joints produces very good function and correction of the ulnar deviation and palmar luxation of the MCP-joints. The arthroplasty is a real alternative to the total endoprosthetic replacement of metacarpophalangeal joints in rheumatoid arthritis.